The effect of anesthetic management during intra-arterial therapy for acute stroke in MR CLEAN

Berkhemer, Olvert A.; Berg, Lucie A. van den; Fransen, Puck S.S.; Beumer, Debbie; Yoo, Albert J.; Lingsma, Hester F.; Schonewille, Wouter J.; Berg, René van den; Wermer, Marieke J.H.; Boiten, Jelis; Nijeholt, Geert J. Lycklama à; Nederkoorn, Paul J.; Hollmann, Markus W.; Zwam, Wim H. van; Lugt, Aad van der; Oostenbrugge, Robert J. van; Majoie, Charles B. L. M.; Dippel, Diederik W.J.; Roos, Yvo B.W.E.M.

doi:10.1212/wnl.0000000000002976

Cited by 172 publications

(172 citation statements)

References 19 publications

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“…Endovascular thrombectomy using a stent retriever is considered an efficient method for blood flow restoration in patients with ischemic stroke due to large intracranial vessel occlusion (1)(2)(3)(4)(5). However, failure of reperfusion persists in a subset of patients due to various factors, such as ICAS (11)(12)(13).…”

Section: Discussionmentioning

confidence: 99%

“…In 2015, five randomized trials showed improved efficacy of endovascular thrombectomy compared with standard medical care in patients with acute ischemic stroke (AIS) caused by arterial occlusion in proximal anterior circulation (1)(2)(3)(4)(5). This procedure is considered the standard of care for patients with proximal anterior circulation occlusions (6).…”

Section: Introductionmentioning

confidence: 99%

“…This procedure is considered the standard of care for patients with proximal anterior circulation occlusions (6). However, the reperfusion rate ranges from 58.7 to 88% (1)(2)(3)(4)(5), indicating that some patients still display failed reperfusion. Compared with the patients included in the previous 5 trials, more individuals with AIS have intracranial atherosclerosis stenosis (ICAS) (7)(8)(9)(10) in Asia.…”

Section: Introductionmentioning

confidence: 99%

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Tirofiban facilitates the reperfusion process during endovascular thrombectomy in ICAS

Zhao

Zhang

Gu³

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. The aim of the present study was to assess the use of tirofiban injections for rescue therapy following artery reocclusion due to intra-luminal thrombosis during endovascular thrombectomy in patients with acute ischemic stroke (AIS). A total of seven cases of patients treated with adjunctive tirofiban injections following failed endovascular thrombectomy due to instant intra-luminal thrombosis were retrospectively assessed. A Solitaire stent was used as the primary thrombectomy device in all patients. Tirofiban was injected intra-arterially via a temporarily deployed Solitaire stent with continuous intravenous infusion for the subsequent 24 h; half of the conventionally recommended dose was employed. Outcome measures included angiographic reperfusion (mTICI), symptomatic intracranial hemorrhage, mortality and functional independence at 90 days (modified Rankin Scale, 0-2). Six patients had occlusions in the middle cerebral artery and one patient had occlusions in the basilar artery. Of the seven patients, five exhibited successful reperfusion (mTICI 2b-3) and achieved functional independence following 90 days. Reperfusion failed in the remaining two patients, who succumbed within 90 days of therapy. No intracranial or extracranial hemorrhage cases were identified. The results of the present study suggest that tirofiban facilitates reperfusion and ameliorates long-term prognosis in patients with AIS undergoing endovascular thrombectomy, and may be safe for those receiving intravenous tissue plasminogen activator therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Tirofiban facilitates the reperfusion process during endovascular thrombectomy in ICAS

Zhao

Zhang

Gu³

et al. 2017

Experimental and Therapeutic Medicine

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“…Use of general anaesthesia was associated with less favourable outcome compared with sedation in a non-randomised, post-hoc comparison and further trials are in progress to address this question. 25 Puncture site complications, such as hematoma or haemorrhage, can occur. 26 Relevant procedural complications reported in the MR CLEAN trial included 5.2% excess incidence of new ischemic stroke in a different vascular territory, embolisation into new territories outside the target downstream territory of the occluded vessel in 8.6%, procedure-related vessel dissections in 1.7% and vessel perforations leading to subarachnoid or intracerebral haemorrhage in 0.9%.…”

Section: Conflicts Of Interestmentioning

confidence: 99%

Thrombolysis and thrombectomy for acute ischaemic stroke

Tawil

Muir

2017

Clinical Medicine

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The likelihood of disability-free recovery after acute ischemic stroke is significantly improved by reperfusion either by intravenous thrombolytic drug treatment or with endovascular mechanical thrombectomy in selected cases. The use of intravenous thrombolysis is limited by the short treatment window and you need to assess individual balance of benefit and risk of symptomatic intracranial haemorrhage. Benefit is greater for shorter onset-to-reperfusion time intervals, requiring optimisation of pre-hospital and inhospital pathways. Symptomatic haemorrhage is more likely with more severe strokes, but a greater proportion of patients are left free of disability than suffer a treatmentrelated haemorrhage at all levels of severity. Extracranial haemorrhage and orolingual angioedema are less common complications. Endovascular mechanical thrombectomy can be used in selected patients with imaging-proven large artery occlusion. Successful therapy depends on well-organised services that can deliver treatment within a short time window at centres with adequate expertise to perform the procedure.

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“…The survival is associated with incomplete MCA territory involvement and atherosclerosis origin (85). Endovascular studies have noticed that patients who require general anesthesia have worse functional outcomes at 90 days versus those who do not require general anesthesia as part of their acute care (86).…”

Section: Airway and Ventilationmentioning

confidence: 99%

Acute Ischemic Stroke Management Review for the Hospitalist

Haldal¹,

Beary²,

Nattanmai³

et al. 2018

Am J Hosp Med

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The effect of anesthetic management during intra-arterial therapy for acute stroke in MR CLEAN

Abstract: This study provides Class II evidence that for patients with acute ischemic stroke undergoing IAT, mRS scores at 90 days improve only in patients treated without GA.

Cited by 172 publications

References 19 publications

Tirofiban facilitates the reperfusion process during endovascular thrombectomy in ICAS

Tirofiban facilitates the reperfusion process during endovascular thrombectomy in ICAS

Thrombolysis and thrombectomy for acute ischaemic stroke

Acute Ischemic Stroke Management Review for the Hospitalist

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